WEIGHT-LOSS SURGERY AND ERECTILE FUNCTION

WEIGHT-LOSS SURGERY AND ERECTILE FUNCTION

02-27-2009

It certainly could, especially for men suffering from obesity-related erectile dysfunction. A clinical study recently published in The Journal of Sexual Medicine showed that obese men with erectile dysfunction had low levels of testosterone. As the severity of obesity increased, the levels of testosterone further decreased.

Excess abdominal fat, cardiovascular disease, high blood lipids and type 2 diabetes have been associated with erectile dysfunction. According to leading sex researcher Dr. Irwin Goldstein, this information may help motivate men to make healthier lifestyle choices.

“This is a landmark study that shows sexual health is clearly linked to overall health,” said Dr. Goldstein, who directs the sexual medicine program at Alvarado Hospital. “Improving one’s general health is an opportunity to improve erectile function.”

However, similar benefits are not as clear for women. Obese women do report more sexual impairment than obese men. However, published studies indicate this may be more related to low self-esteem, unsatisfactory relationships, social stigma and other psychological issues.

“A woman’s libido can be affected by many factors, such as the stress of caring for a sick relative,” Dr. Goldstein said. “There is no evidence yet to indicate that weight-loss surgery automatically makes sex better.” He added that when it comes to sexual activity, body size doesn’t always matter. Thin, healthy people may be perceived as having the best body image and sexual function, but that is not always the case.

“There are plenty of sexually active heavy people and sexually inactive thin people,” Dr. Goldstein said. “I see them every day in my practice.”

A New Body Image

Just as weight-loss surgery requires life-long behavioral changes in nutrition and exercise, body image must also be addressed. As the pounds come off, patients often find other people start responding differently to them. It is not uncommon for a partner to expect more sex. Additionally, some patients may become uncomfortable about increased attention from strangers.

Then there’s the new reflection in the mirror. A weight loss of 100 pounds or more may leave folds of excess skin. Plastic surgery is effective, but it is costly and not always covered by health insurance.

Psychologist Lisa Steres, Ph.D., who provides counseling for bariatric surgery patients at Alvarado Hospital, says it can take years for a patient’s brain to catch up with the new body. As part of her pre-surgical evaluation, she asks delicate yet direct questions: How has the weight impacted sexual relationships? How do they expect the weight loss to impact their sex life.

Dramatic changes during the transition to a normal weight can impact self-esteem and confidence. During the pre-surgical evaluation, Dr. Steres prepares patients to expect this, so they may come back and discuss it if necessary.

Dr. Steres said that both patients and partners typically go through stages of being relieved about the reduced medical concerns, but are then surprised at their own responses to the excessive skin that often results from massive weight loss. Some patients choose to consult with a plastic surgeon, while others are just as content as they were before the weight loss.

“Occasionally, a woman doesn’t like how she looks after surgery without her clothes on,” Dr. Steres said. “But when patients are basically happy people in loving, caring relationships, we find they work these things out.”

Weight-Loss Surgery May Boost Fertility

Since fat stores estrogen, excess weight acts as a natural form of birth control. Women who previously struggled with infertility may find it much easier to become pregnant after surgery. For this reason, women of childbearing age are advised to undergo the gastric banding or “lap band” procedure.

“It may be risky to become pregnant within the first 18 months after gastric bypass Roux-En-Y surgery,” said bariatric surgeon Dr. Sunil Bhoyrul, who performs both that procedure and gastric banding at Alvarado Hospital. “The gastric bypass procedure limits the absorption of food, which would cause serious problems for a developing fetus.”

For the same reason, gastric bypass patients also cannot rely on birth control pills. They simply may not be able to absorb enough of the hormones for oral contraception to be effective. Dr. Bhoyrul advises patients in the first 18 months after surgery to use barrier contraceptives.

Patients at Alvarado Hospital undergo a comprehensive medical and psychological evaluation prior to surgery to be sure they understand the full physical and psychological ramifications of weight-loss surgery. This includes an assessment for possible food addictions. Since surgery limits the amount of food patients may eat, a food addiction could transfer to sex, gambling or alcohol. “Addiction transfer,” as it is known, seems to be more common after gastric bypass than after gastric banding.

“We assess any issues that may impact a patient’s ability to use the surgery as an effective weight-loss tool,” Dr. Bhoyrul said. “People should not have the surgery unless they are part of a comprehensive program that includes medical, psychological and sexual counseling. This is essential to helping patients make a fully informed consent.”